Time to aortic occlusion: It's all about access.

Introduction: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a less invasive method of proximal aortic occlusion compared to resuscitative thoracotomy with aortic cross-clamping (RTACC). This study compared time to aortic occlusion with REBOA and RTACC, both including and excluding time required for common femoral artery (CFA) cannulation. Methods: Retrospective, single institution, review of REBOA or RTACC performed between Feb 2013 and Jan 2016. Time of skin incision to aortic cross-clamp for RTACC; time required for common femoral artery (CFA) cannulation by percutaneous and open methods, and time from guide-wire insertion to balloon inflation at Zone 1 for REBOA, were obtained from videographic recordings. Results: 18 RTACC and 21 REBOAs were performed. Median time from skin incision to aortic cross clamping was 317 [227,551]s. Median time from start of arterial access to Zone 1 balloon occlusion was 474 [431,572]s (vs. RTACC, p=0.01). All REBOA procedures were performed with the same device. The median time to complete CFA cannulation was 247 [164-343]s, with no difference between percutaneous or open procedures (p=0.07). The median time to aortic occlusion in REBOA once arterial access had been established was 245 [179,295.5]s, which was significantly shorter than RTACC (p=0.003). Conclusions: Once CFA access is achieved, time to aortic occlusion is faster with REBOA. Time to aortic occlusion is less than the time required to cannulate the CFA either by percutaneous or open approaches, emphasizing the importance of accurate and expedient CFA access. REBOA may represent a feasible alternative to thoracotomy for aortic occlusion. Time to aortic occlusion will likely decrease with the advent of newer, REBOA technology. The rate-limiting portion of REBOA continues to be obtaining CFA access. Level of evidence: Therapeutic, Level V (C) 2017 Lippincott Williams & Wilkins, Inc.

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